Thomas Schmitz-Rixen initially considered being a sociologist. However, he began to gravitate towards the world of medicine following a discussion with his school principal. His first interest in vascular medicine came from watching microvascular surgery on television, a procedure that captured his imagination. After completing a doctoral thesis on vascular bioprosthesis, he was left with “no choice” other than vascular surgery. Schmitz-Rixen spoke with Vascular News about his pioneering research and his role in shaping the path of vascular surgery in Germany.
Why did you decide you wanted a career in medicine, and why in particular did you choose to enter the vascular field?
Shortly before finishing secondary school I was considering a career in sociology. After a talk with the school principal, to whom I was especially close due to my role as student spokesman, the wish to additionally study medicine began to crystallise. After the first semester, medicine is what stuck. Around this time I saw a television broadcast about microvascular surgery and was fascinated. I did not then know that I would later prepare hundreds of experimental microvascular anastomoses. My entrance into vascular surgery began with a doctoral thesis about vascular bioprostheses. That meant that as a student I was already carrying out complex vascular operations on large animals. After that, I had no other choice than to go into vascular surgery.
Who have been your most important career mentors and what wisdom did they impart?
I learned my surgical handicraft from Heinz Pichlmaier in Cologne, my vascular surgery skills from Svante Horsch also in Cologne, and I built an academic and research portfolio together with Bill Abbott in Boston. I have also been greatly influenced by Wolfgang Schaper, the head of the Arteriogenesis Research Group at the Max-Planck-Institute in Bad Nauheim, with whom many years of fruitful collaboration have led to a better understanding of the molecular mechanisms connected with collateral growth.
What has been the biggest development(s) in vascular medicine during the course of your career?
Aside from the endovascular revolution, I would say our increased understanding of vascular biology. In a device-driven area, this is certainly a tender little sprout, but still of great importance in developing further treatment strategies. I am extremely pleased that more and more young investigators are realising how important this facet of vascular medicine is.
What is the most interesting paper or presentation that you have seen recently (aside from your own research)?
It is an article by Giovanni Maio, titled “Why medicine must find its way back to medical thinking”, that has influenced my political thinking and action. As president of 2,700 vascular surgeons and soon of approximately 25,000 surgeons, I feel responsible for the working conditions and freedom of our members in regard to medical issues. Excessive commercial and economic interests must be subordinate to our delicate and unique physician-patient relationship and we must clearly stand up in the patient’s interests.
In this respect I call for a future-oriented, sustainable, and effective public health care policy:
- Intensive cooperation between public health policy and scientific medicine
- Independent financing to develop and implement guidelines
- Coordination between human and veterinary medicine to protect against infection
- Improvement in the framework for health research
- Independent personnel development and encouragement and support of young medical colleagues.
What are your current research interests?
We are working with ultrasound speckle tracking to determine the biomechanical properties of the aortic wall in hopes of developing a model to predict abdominal aortic aneurysm perforation. We are also pursuing experimental and translational possibilities to enhance collateral development in ischaemic tissue. Clinical trials concerning gene therapy to induce collateral growth is another research area in which we are taking part. We are also directing a Europe-wide study with regard to the endovascular introduction of an arteriovenous fistula. According to the data of the German Aneurysm Register we have just been able to develop a dual risk score regarding endovascular versus open revision of abdominal aortic aneurysms, which seems to be superior to the existing score.
You are the current president of the DGG (Deutsche Gesellschaft für Gefäßchirurgie); what parts of this year’s meeting in Frankfurt are you most excited about?
The motto for the 33rd annual meeting of the DGG is: “Commitment to our successors”. I am pleased to report that this motto has already found much positive resonance. We have incorporated many elements with regard to promoting young colleagues. This begins with the opening speech of the eminent medical ethicist Giovanni Maio with the title, “What must vascular surgeons pass on to their successors?” Every scientific session will have a junior chairman or woman in addition to the regular chair and many meetings and courses are addressed to our younger colleagues from a clinical and academic viewpoint.
What are the main goals of the Society when it comes to developing the speciality in Germany?
The main goals are to widely disseminate endovascular expertise and to anchor education guidelines in regional medical chambers. We also want to propagate the possibility and right of vascular patients to be treated—from diagnosis through all therapeutic modalities and secondary prophylaxis—by vascular specialists.
Can you tell us about the Society’s work in ensuring treatment standards, for example at your teaching academies?
Starting this year the DGG academy has revised our long-standing curricular specifications for training courses in endovascular surgery. Certificates with the title “Endovascular Surgeon” or “Endovascular Specialist” are only conferred after passing an exam. Teachers and tutors must also take a course “Teach the Teacher”. Furthermore, we are investing considerable funding in reissuing 10 different diagnostic and therapeutic guidelines, subject to strict multidisciplinary standards and controlled by the AWMF (Association of the Scientific Medical Societies in Germany).
Regional variations in thoracoabdominal aneurysm care remain in Germany—ie. whether patients are treated with open or endovascular surgery; Is this something that the Society plans to address?
We are indeed seeing regional variation in treating thoracoabdominal aneurysms, not so much for the descending thoracic aneurysm, which is almost completely endovascularly treated. I am noticing that vascular surgeons are increasingly treating thoracoabdominal aneurysms endovascularly or referring patients to appropriate centres of expertise. Cardiac surgeons with affiliated vascular surgery are also increasingly beginning to treat thoracoabdominal aneurysms endovascularly. This year the German Vascular Society is offering endovascular advanced training courses to our colleagues in cardiac surgery.
Could you tell us about one of your most memorable cases? What did this experience teach you?
Cases with an unexpected outcome are the ones from which you learn the most. In fact, there is one case with a happy ending, which showed me that you should not give up, even in the most desperate of situations. This was the case of a 55-year-old man with an acute Stanford type B dissection, complete obstruction of all abdominal arteries and both common iliac arteries, who came into my care with some delay. After laparotomy, it was apparent that a large part of the intestine was already necrotic. Through laborious fenestration, it was possible to bring organs and both legs back onto the grid. The man survived with considerable intestinal loss and required parenteral nourishment. Three years later a small intestine transplant was carried out, whereby I was able to reconnect the lymphatic system. My experience in microsurgery was invaluable here. Two years later I was able to repair a thoracic aortic false lumen aneurysm by employing a stent-graft. This man survived a total of nine years with a good quality of life.
What are some of the proudest moments in your career?
The first was a grant from the Deutsche Forschungsgemeinschaft (German Research Foundation) to finance a two-year research period at Massachusetts General Hospital in Boston, then in 1998, the Professorship for Vascular Surgery at the Goethe-University in Frankfurt am Main. Being elected as president of the German Society for Vascular Surgery and Vascular Medicine for 2017-2018 and then elected as president of the German Society for Surgery for 2019-2020 are also proud moments.
What three questions in vascular medicine still need to be answered?
- Development and prevention of calcification
- Development and growth deceleration of aneurysms
- Collateral growth.
What advice would you give to young vascular surgeons starting out in their careers?
Recognise your capabilities, make these your goals and pursue them. Aspire to a largely independent position.
Is there anything else that you would like to mention that we have not yet covered?
No so wonderful a career is possible without family support. I am infinitely grateful to my wife Simone and our two children for their understanding. I sincerely hope that it will be possible for me to continue to let them know that they are the absolutely first priority in my life.
What are some of your hobbies and interests outside of medicine?
Photography (I never leave home without a camera), skiing, hiking, and collecting modern art.
1998 Professor for Vascular Surgery, Frankfurt am Main – Goethe-University, Frankfurt, Germany
1998 Director of the Department of Vascular and Endovascular Surgery and University Comprehensive Wound Center, Goethe-University Hospital, Frankfurt, Germany
2002 Research Associate at the Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
2017–18 President of the German Vascular Society
2017 Vice-President of the German Society for Surgery and Incoming President for 2019–20
1983 MD, University of Cologne, Cologne, Germany
1985–87 Fellow and House Officer in surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
1988–94 Gerhard-Hess-Scholarship of the Deutsche Forschungsgemeinschaft (DFG), “Biologic reconstructions in vascular surgery”
1995 PhD, University of Cologne, Cologne, Germany
Previous positions (selected)
1987–91 Junior Consultant for Surgery in the University of Cologne Department of Surgery, Cologne, Germany
1988-98 Director of the Vascular Research Lab in the University of Cologne Department of Surgery, Cologne, Germany
1992–98 Senior Consultant in Surgery and Vascular Surgery in the University Department of Surgery Cologne, Cologne, Germany
1997–98 Consultant for Palliative Surgery, Dr Mildred Scheel House, Cologne, Germany